Provider Demographics
NPI:1114050747
Name:BORRERO, MAYRA E (BD)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:E
Last Name:BORRERO
Suffix:
Gender:F
Credentials:BD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0532
Mailing Address - Country:US
Mailing Address - Phone:787-876-4863
Mailing Address - Fax:
Practice Address - Street 1:LOIZA VALLEY MALL
Practice Address - Street 2:SUITE AA-12
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0000
Practice Address - Country:US
Practice Address - Phone:787-876-3400
Practice Address - Fax:787-876-7631
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist